ABSTRACT
Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially treu in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral syncrhony (SBS). High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrial simulation. She was submitted to a right frontal lobe resection, 1,5 cm ahead of the motor strip and has been seizure free since surgery (8 months). Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.
Subject(s)
Adolescent , Humans , Female , Epilepsy, Frontal Lobe/pathology , Epilepsy, Frontal Lobe/surgery , Frontal Lobe/pathology , Frontal Lobe/surgery , Seizures/pathology , Brain Mapping , Electrodes, Implanted , Electroencephalography , Magnetic Resonance Imaging , Subdural Space , Tomography, Emission-Computed, Single-PhotonABSTRACT
Se presenta y analiza un protocolo en cirugía resectiva córtico-focal en epilepsias focales lesionales fármaco resistentes con lesión visible única a la neuroimagen, iniciado en el Instituto de Neurocirugía e Investigaciones Cerebrales Asenjo en 1990. Hasta la fecha se han operado 40 pacientes, 32 (80 porciento) niños, 8 (20 porciento) adultos. El área más frecuentemente intervenida fue el lóbulo temporal en 24 casos (60 porciento); la cirugía extratemporal se practicó en 16 pacientes, frontal en 11 y parietal en 5. No hubo mortalidad y 2 pacientes quedaron con secuela de defecto del campo visual